Laryngeal myxoedema: a literature review of an uncommon complication of hypothyroidism

2021 ◽  
Vol 14 (4) ◽  
pp. e241313
Author(s):  
Mian Harris Iftikhar ◽  
Fazal I Raziq ◽  
Patrick Coll ◽  
Aneeqa Yousaf Dar
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Respiratory Tract ◽  
Therapeutic Options ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Invasive Ventilation ◽  
Upper Respiratory ◽  
Uncommon Complication

A 59-year-old woman presented to the emergency department with shortness of breath. She had significant oropharyngeal swelling obstructing her upper respiratory tract. A diagnosis of laryngeal myxoedema was made, which was attributed to severe hypothyroidism. She required invasive ventilation and subsequently a tracheostomy. She was treated with levothyroxine and hydrocortisone. She completely recovered with this therapy. In this review, we will discuss similar cases and different therapeutic options. This case also highlights the fact that establishing a diagnosis of laryngeal myxoedema, a condition that can potentially have lethal outcomes and can be challenging.

To proceed or not to proceed: ENT surgery in paediatric patients with acute upper respiratory tract infection

2016 ◽  
Vol 130 (9) ◽  
pp. 800-804 ◽  
Author(s):  
S Shemesh ◽  
S Tamir ◽  
A Goldfarb ◽  
T Ezri ◽  
Y Roth
Keyword(s):  
Tract Infection ◽  
Literature Review ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Surgical Procedures ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Risk Benefit Assessment ◽  
Upper Respiratory ◽  
The Impact

AbstractBackground:Upper respiratory tract infection is the most common non-preventable cause of surgery cancellation. Consequently, surgeons and anaesthesiologists involved in elective ENT surgical procedures frequently face a dilemma of whether to proceed or to postpone surgery in affected children.Methods:A literature review was conducted and a practical assessment algorithm proposed.Conclusion:The risk–benefit assessment should take into consideration the impact of postponing the surgery intended to bring relief to the child and the risks of proceeding with general anaesthesia in an inflamed airway. The suggested algorithm for assessment may be a useful tool to support the decision of whether to proceed or to postpone surgery.

scholarly journals Acute Respiratory Distress Syndrome Caused by Human Adenovirus in Adults: A Prospective Observational Study in Guangdong, 2019–2020

2021 ◽  
Author(s):  
Zhan Wu ◽  
Rong Zhang ◽  
Dongdong Liu ◽  
Xuesong Liu ◽  
Jierong Zhang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Characteristics ◽  
Distress Syndrome ◽  
Early Stage ◽  
Invasive Mechanical Ventilation ◽  
Viral Pneumonia ◽  
Upper Respiratory Tract ◽  
Shortness Of Breath ◽  
Upper Respiratory

Abstract Background: Viral causes of acute respiratory distress syndrome (ARDS) are mostly limited to influenza. However, adenovirus has been emerging as a cause of ARDS with a high mortality rate and described in adults are rare.Methods: We conducted a prospective, single-center observational study of viral pneumonia with ARDS and confirmed adenovirus-associated ARDS in adults at our quaternary referral institution between March 2019 and June 2020. We prospectively analyzed clinical characteristics, laboratory test results, radiological characteristics, viral load from nasopharyngeal swabs and endotracheal aspirates, treatments, and outcomes for the study participants.Results: The study enrolled 143 ARDS patients, including 47 patients with viral pneumonia-related ARDS, among which there were 14 adenovirus-associated ARDS patients, which accounted for 29.79% of the viral pneumonia-related ARDS cases. Among the adenovirus-associated ARDS patients, 78.57% were men with a mean age of 54.93 ± 19.04 years. Adenovirus-associated ARDS patients had no specific clinical characteristics, but they presented with shortness of breath and fever, and their initial chest radiographic findings were multifocal or showed diffuse opacity. The viral load and the positivity rate in the lower respiratory tract were higher than that of the upper respiratory tract in the patients with adenovirus-associated ARDS, and 85.71% of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. All patients required invasive mechanical ventilation treatment. The average time from shortness of breath to the application of invasive ventilation was 24 hours. The median duration of invasive mechanical ventilation was 22 days (14–75 days). Six patients (42.86%) required renal replacement therapy, and three patients (21.43%) required extracorporeal membrane oxygenation support. Additionally, 85.71% of the 14 adenovirus-associated ARDS patients survived.Conclusion: Adenovirus infection is an important cause of virus-related ARDS. The positivity rate of adenovirus infection in lower respiratory tract secretions was higher than that in upper respiratory tract secretions in these patients. Most of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. Early identification and intervention to prevent disease progression are essential for reducing the mortality rate in these patients.

How Evidence-Based is our Practice in a Hong Kong Emergency Department?

2003 ◽  
Vol 10 (4) ◽  
pp. 202-214
Author(s):  
PKM Pang ◽  
B Lim ◽  
KP Lee ◽  
CL Lok ◽  
CS Chung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Daily Practice ◽  
Upper Respiratory Tract Infection ◽  
Evidence Based ◽  
Upper Respiratory Tract ◽  
Positive Interventions ◽  
Upper Respiratory

Objective To evaluate how evidence-based our daily practice was. Design Retrospective study. Setting Emergency department of a public district hospital. Patients and Methods Between 1st August 2000 to 7th August 2000, 91 patients' records were chosen at random. A chief diagnosis was assigned for each patient. Corresponding treatments were reviewed by searching relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses. Each patient had only one chief diagnosis but could have multiple interventions for that diagnosis. Results Out of 91 records, 14 were discarded. All of them had not been given any intervention and 11 required admission. For the remaining 77 records, there were 38 subjects in medical, paediatric, or gynaecological specialties and 39 in surgical or orthopaedic specialties. Intervention(s) given for each subject were then searched electronically through our hospital Knowledge Gateway and the results were expressed as either EBM-positive or EBM-negative. “EBM-positive” interventions denoted a support by RCTs. “EBM-negative” interventions denoted an absence of any supportive RCTs. Each patient might have EBM-positive and/or EBM-negative interventions together if that patient received more than one treatment. There were 52 patients (52/77 = 68%) who had one of their interventions being RCT-supported. The majority were patients with (1) antipyretic use of paracetamol in upper respiratory tract infection, or (2) control of pain by nonsteroidal anti-inflammatory drug, dologesic and paracetamol. There were 25 patients (25/77 = 32%) who did not receive any RCT-supported interventions. Concurrently 53 patients out of 77 (69%) received EBM-negative interventions. The majority were patients with (1) the use of antibiotics, antitussives and antihistamines in upper respiratory tract infection, (2) antispasmodics in gastroenteritis or patients with nonspecific abdominal pain, and (3) the use of analgesic balm in minor orthopaedic complaints. Conclusion Sixty-eight percent of patients had EBM-positive interventions. Thirty-two percent of patients did not receive any EBM-positive intervention. It was quite encouraging as compared to studies in other specialties with similar design. Concurrently 69% of patients had also been given EBM-negative interventions. There were areas for improvement if we were to implement EBM practice in the emergency department.

scholarly journals An Analysis of Unscheduled Return Visits to the Accident and Emergency Department of a General Public Hospital

2003 ◽  
Vol 10 (3) ◽  
pp. 153-161 ◽  
Author(s):  
CP Ng ◽  
CH Chung
Keyword(s):  
Emergency Department ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Related Factors ◽  
Public Emergency ◽  
Upper Respiratory ◽  
Return Visits

Objectives To identify the reasons for unscheduled return visits to a public emergency department and possible strategies to reduce unscheduled return visits. Design Cross-sectional survey. Setting A public emergency department in Hong Kong. Patients Unscheduled return visits within 48 hours in a three-month period from 14 January 2000 to 15 April 2000. Main outcome measures Patients' epidemiological characteristics, reasons, complaints and outcome of the unscheduled return visits. Results During the study period, 3.3% (1,060) of the attendance was unscheduled return visits within 48 hours as recorded in the computerized A&E Information System of the hospital. However, only 738 patients (70%) responded to the questionnaire. These 738 patients formed the study population for further analysis. Illness-related factors accounted for 87% of the total unscheduled return visits. Patient-related factors were responsible for about 10% of unscheduled return visits. Doctor-related factors accounted for about 3% of unscheduled return visits. There was only one system-related unscheduled return visit. For the outcome of return visits, about 76% (559) was discharged after the second consultation. About 5% (40) was referred to specialist clinics. Around 24% (179) of patients was admitted. Of those admitted, 78% (140) was illness-related, 13% (23) was patient-related and 9% (16) was doctor-related. Upper respiratory tract infection was the most frequent complaint (34%), followed by painful conditions (23%) and injuries (10%). For children at or below 10 years of age, upper respiratory tract infection (60%) and febrile illness (15%) were the most frequent complaints. Conclusions The study found that the reasons for return visits were multiple. These “unscheduled return visits” should not be automatically regarded as poor indicator of service. Better patient education, organized family practice system, upgrading of professional training and targeted audit are possible means to reduce unscheduled return visits.

scholarly journals 1466. Antibiotic utilization reports may reduce prescribing practices for Upper Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S735-S735
Author(s):  
David Augusto Terrero Salcedo ◽  
Allison Kelly ◽  
Victoria Tate
Keyword(s):  
Emergency Department ◽  
Respiratory Tract ◽  
Antibiotic Prescription ◽  
Upper Respiratory Tract ◽  
Care Providers ◽  
Post Intervention ◽  
Face To Face ◽  
Antibiotic Utilization ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background More than 90% of Upper respiratory tract infections (URI) have a viral etiology; nonetheless, these represent the most common reason for ambulatory antibiotic prescription. This translates in higher risk of antibiotic-related adverse events and promotion of antimicrobial resistance. Methods A prospective single-center intervention surveying and providing individual, face-to-face comparative reports of antibiotic utilization, for any of the 4 diagnostic entities that constitute upper respiratory tract infection (common cold, pharyngitis, acute rhinosinusitis and acute bronchitis), was performed in our Emergency Department. Example of monthly provider reports used which included general and individualized goals. Results A total of 12 health care providers were followed for 12 months. Education, prescribing reports and individual goals were provided. The pre-intervention prescription rate from September to December 2018 averaged 74.75% (SD 20.59, 95% CI 61.6-87.8), with a post-intervention rate of 55.5% from September to December of 2019 (SD 19.20, 95% CI 43.3-67.7) that was statistically significant (p=0.0036). A higher use of antibiotic was observed in physicians when compared to non-physician providers in both pre and post intervention stages (reduction of 16.6% vs 23% after intervention respectively), with no statistical difference between the two groups (CI 95% of -38.82 to 2.395, p=0.0773). A proposed target of 50% or less was observed in 5 of 12 providers (41.6%), and 2 out of 12 (16.7%) had increase in their antibiotic utilization rate. Comparative use of antimicrobials in the pre (September-December 2018) and post (September-December 2019) - intervention periods. Average individual antimicrobial use rate before and after intervention. Conclusion Routine face-to-face utilization reports may constitute an effective approach in reducing antibiotic prescription practices in the Emergency Department, and potentially, in other outpatient healthcare settings. Disclosures All Authors: No reported disclosures

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